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Understanding mental illness

By Barbara Ryanand Susan Marine

Posted:
03/17/2013 01:00:00 AM MDT

When we are confronted with unfathomable tragedy, tragedy that strikes at the heart of our belief in humanity and in one another, we understandably seek any avenue to prevent its recurrence. This is how mental illness and violence have become linked in our public discourse.

Contrary to the portrayal this implies, the face of mental illness is very different to those of us who work daily with individuals whose lives are impacted by mental illness. The faces we see include:

The appreciation and quiet dignity on the face of the young man whose hard work learning to manage his illness has led to completion of his college degree.

The genuine delight and self-confidence on the face of the woman who is working after years of thinking she might never experience the satisfaction of a job well done again.

The tears of joy on the face of the woman who has worked with her therapist and nurse team to conquer her history of trauma and substance use to successfully parent her children and preserve the family she loves.

The quiet competence and determination on the face of the man who has transformed his life and works to help others find their path to recovery from mental illness and substance use.

And there are also the faces of people who struggle to control the symptoms of their illness, who are experiencing relapse, and who fear the solid ground beneath them is slipping away.

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We rarely see the face of angry violence, probably no more often than you might see in the course of your work day. In fact, people who are diagnosed with mental illness are much more likely to be the victim of violence than to be violent themselves. Only three to five percent of all violent crimes are committed by someone with a diagnosable mental illness.

The best research reveals that violence is associated with a complex set of factors that, while helping us understand some of the societal dynamics that may contribute to violent behavior, mean that it is very difficult to predict violence at an individual level. In reviewing the literature, the Harvard Mental Health Letter (January 2011) concludes that the findings indicate "a more complex picture about mental illness and violence. They suggest that violence by people with mental illness -- like aggression in the general population -- stems from multiple overlapping factors interacting in complex ways. These include family history, personal stressors (such as divorce or bereavement), and socioeconomic factors (such as poverty and homelessness)." (Emphasis added.)

At the same time, mental illness can result in a crisis situation, sometimes due to lack of treatment and sometimes due to relapse. Tragically, these circumstances can sometimes lead to expressions of violence, the majority of which are violence directed towards the self; indeed, three-fourths of all gun deaths in Colorado are due to suicide.

The governor's budget proposal to the Joint Budget Committee includes significant additional funding for mental health crisis services, including multiple walk-in crisis stabilization centers and a statewide crisis line. The proposal also includes provisions that will help ease the shortage of inpatient psychiatric beds as well as help to fund training in trauma-informed treatment, based on the recognition that many individuals with mental illness have suffered from physical or sexual abuse.

Mental Health Partners and the 16 other community mental health centers throughout the state support the governor's proposal and have recommended that the additional funding be used to build on the strong, statewide, public mental health system, opening the existing system of services to everyone regardless of payer source. Services can be strengthened, and the governor's budget proposal will serve that end.

Mental illnesses are disorders of the brain and, as such, are not really that different from diabetes or heart disease. Recovery rates from mental illnesses equal or surpass recovery rates for many physical illnesses. Unfortunately, the fear and stigma associated with mental illness and substance abuse often create barriers to seeking care. Frequently people deny the symptoms of mental illness -- sometimes out of ignorance. These dynamics interfere with early diagnosis and treatment, which research has shown can prevent more serious illness later in life. Studies have also shown that those with serious mental illness die, on average, 25 years sooner than the general population. Those with mental illness face considerable challenges, and they need and deserve the support of the community.

We must work together to make sure that people who struggle with mental illness and substance use disorder are not the latest group of people that we allow ourselves to ostracize and reject based solely on our fear and misunderstanding. For we also see the impact of this prejudice on the faces of people with mental illness.

There are many faces of mental illness, as we have suggested. The people behind those faces have the same hopes as other people -- to live, work, learn, and participate fully in the community.

Barbara Ryan is the Chief Executive Officer of Mental Health Partners; Susan Marine is the Chair of the Board of Directors.

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